So while the bar is admittedly very low, in nominating as the next surgeon general Jerome Adams, the pro-needle exchange health commissioner of Indiana, Trump has made a positive, thoughtful choice that appears to be to most everyone’s immediate benefit.

Maybe it’s all an accident, but some accidents can be happy—and these, we can celebrate.

But. Adams may soon inherit an absolute public-health disaster—not of his own making—but one that he should immediately identify and pressure his soon-to-be boss to avoid at all costs.

Adams, 42, was nominated for the post in late June. In some ways, it’s a typical Trump pick, where loyalty, familiarity and continuity are valued above ability: Adams was appointed Indiana health commissioner in October 2014 by Vice President Mike Pence. (As it happens, another former Indiana health official is in a key post overseeing Medicaid and Medicare.)

But, at least on its face, the pick sends a clear message that the Trump administration is taking the opioid crisis seriously and is willing to reward people who buck convention.

“Dr. Adams navigated the very ideological political environment that was created by then-governor Pence,” Beth Meyerson, co-director of Indiana University’s Rural Center for AIDS/STD Prevention, told Kaiser Health News. “There’s just no doubt the governor wouldn’t have listened to me or listened to the leaders in the legislature, but he would listen to Jerome Adams.”

Trump first had face time with Adams back in November, well before the president backed a plan to eliminate the massive Medicare expansion under Obamacare that’s currently providing healthcare to millions of Americans, including many in Indiana—and, as STAT News pointed out, the impoverished people of Austin, Indiana, where the HIV outbreak was centered, which had been without free HIV testing since 2013, when a Planned Parenthood clinic closed.

It’s not clear whether Adams will have either the principles or the opportunity to challenge the president if his nomination is approved—and it’s also somewhat discouraging to consider that all it takes to become one of the most progressive, solution-oriented members of Team Trump is to value lives over morals and embrace a proven method supported by virtually the entire public-health community.

The job of surgeon general is mostly that of an advocate.

Past surgeons general have used the job to advocate for gun control, against smoking and against obesity. If Republicans in Congress are successful in their quest to quash Obamacare and leave more than 20 million Americans without health insurance, maintaining public health will be impossible. Opioid abuse and HIV infections will worsen. People will die.

No public-health official who takes his or her job seriously would stand for it. In an ideal world, Adams would refuse the job until such time as the Trump “repeal and replace” was abandoned, or at least until it included “replace.”

How deep are Adams’s scruples? We will find out, and we will know by the body count.